Researchers cite increase in ACL reconstructions, identify groups at risk for further surgery

Ortho Supersite—October 2, 2009

A study of patients who underwent ACL reconstruction shows that those treated by surgeons who only perform a minimal number of ACL reconstructions are more likely to need subsequent knee surgery.

The research conducted by investigators at Hospital for Special Surgery in New York also indicated that 6.5% of all patients who had an ACL reconstruction underwent an additional knee procedure on either knee within 1 year.

“It is a small minority of patients who need further surgery early on, but that is a lot of trips back to the operating room considering how much surgery is done,” Robert Marx, MD, a co-author of the study and orthopedic surgeon in the Sports Medicine and Shoulder Service at the hospital, said in a Hospital for Special Surgery press release. “This is the largest study to look at factors that may affect subsequent surgeries after ACL reconstruction.”

The study appears in the October total knee issue of The Journal of Bone and Joint Surgery.

Using the New York State Department of Health’s Statewide Planning and Research Cooperative System database, Marx and his colleagues identified more than 70,000 ACL reconstructions performed in the state between 1997 and 2006.

The investigators discovered that these procedures dramatically increased 21.5% during the study period, Marx said in the press release.

In addition to being the first study to report that women have a higher risk of subsequent surgery following ACL reconstruction, the investigators discovered that 1.9% of all patients in the study underwent a second ACL reconstruction within 1 year.

They also found that patients younger than 40 years and those who were treated at hospitals that had a low volume of ACL reconstructions were more likely to undergo a second ACL reconstruction.

“Patients need to understand that younger individuals who undergo an ACL reconstruction have a higher risk of retear,” Marx said in the release. “The risk is not the same for all patients. Patients also need to know that being operated on by a lower-volume surgeon has a higher risk of reoperation.”